Mastering the Foundations of BHRT: Evidence-Based BHRT Training

Introduction to Cancer and Hormones - This section looks to reframe cancer not simply as a genetic disease of random mutations, but as a complex, metabolic disorder driven by disruptions in the cellular environment and regulatory systems. The emphasis is that cancer is a disease of dysregulated growth, rooted in dysfunctional cellular communication and influenced heavily by chronic insulin elevation, inflammation, and hormonal imbalances—particularly hyperinsulinemia and insulin resistance. Rather than focusing solely on DNA mutations, Dr. Jason Fung in his book The Cancer Code, proposes that cancer results from a breakdown in the body's natural checks on growth and repair, largely triggered by lifestyle factors such as poor diet, obesity, and chronic stress. He also critiques the limitations of the traditional mutation-centric model and advocates for a paradigm that integrates evolutionary biology and metabolic regulation to better understand—and prevent—cancer through systemic and lifestyle-based interventions.

• What is cancer and why has it alluded us
• Myths and controversies surrounding ‘hormones cause cancer

Gayle Frazzetta MD

• How hormones relate to or are affected by these cancers
• To recommend or not recommend
• What the emerging literature says

Gayle Frazzetta, MD

Vaginal Atrophy and Dysfunctional Bleeding - During menopause, women lose estrogen which causes a myriad of side effects other than hot flashes and nightsweats. During this change women experience genitourinary symptoms that can be embarrassing and debilitating such as vaginal dryness, loss of libido, stress or urgency incontinence, and recurrent urinary tract infections. These symptoms can be chronic and progressive and need intervention to improve. Even though it’s estimated that about half of women experience these symptoms, only a small percentage discuss these challenges with their providers. Abnormal and dysfunctional uterine bleeding can occur to a woman during any stage of life. It is important for any practitioner who treats women to be able to understand what these terms mean and how to treat these patients. This lecture will review the pathophysiology, clinical presentation, and evaluate literature for management strategies of vaginal atrophy, abnormal and dysfunctional uterine bleeding.

• Terms
  • Vaginal atrophy
  • Vulvar atrophy
  • Genitourinary Syndrome of Menopause (GSM)
  • Abnormal uterine bleeding
  • Dysfunctional uterine bleeding
  • Treatment
    • Non prescription probiotics for vaginal health
    • DHEA
    • Testosterone
    • Estradiol
    • Tranexamic Acid
    • Progesterone
    • IUDs
    • Oral contraceptives

    Connie Casad, MD

Hormones and Breast Cancer - The controversy surrounding breast cancer and hormones, particularly hormone replacement therapy (HRT), stems from conflicting data on whether exogenous hormones—especially synthetic estrogens and progestins—increase breast cancer risk. The Women's Health Initiative (WHI) study in the early 2000s linked certain forms of HRT to a modest rise in breast cancer incidence, prompting widespread fear and decline in hormone use. However, subsequent analyses have revealed that the risks vary significantly based on hormone type, route of administration, timing of initiation, and individual patient factors. Emerging evidence suggests that bioidentical hormones, particularly estradiol and micronized progesterone, may carry a more favorable safety profile. The ongoing debate highlights the need for further education on the latest evidence and underscores distinctions between synthetic and bioidentical hormone therapies in evaluating breast cancer risk.

• Historical look at the WHI and differentiating estradiol and progesterone vs CEE and progestins
• Current literature review on the use of estradiol and breast cancer
• The use of tamoxifen in the treatment of breast cancer
• BRCA genetic testing
• Current literature review on the use of progesterone in breast cancer

Gayle Frazzetta MD

Progesterone for Women - Endogenous sources, important metabolites and receptor site locations. Progesterone vs progestin, understanding the differences. Literature review for decreased blood pressure, breast cancer protection, symptoms of PMS, menopause and post-partum depression. Protective benefits for osteoporosis as well as breast and endometrial cancer and improvements for sleep.

• Literature Review
• Types | Dosing | Methods of Administration
• Goals of Treatment
• Side Effects
• Concerns and Issues
• Indications | Contraindications
• Case Studies
Faculty: Lauren Fitzgerald, MD

Estrogen for Women -Endogenous sources of estradiol, important metabolites and receptor site locations. Different types of estrogen along with pros and cons. Estrogen vs estradiol. The benefits and misunderstanding for estrogen is vast; prepare to dissect it and come away with much more confidence in using this hormone.

• Literature Review
• Types | Dosing | Methods of Administration
• Goals of Treatment
• Side Effects
• Concerns and Issues
• Indications | Contraindications
• Case Studies
Faculty: Gayle Frazzetta, MD

Estrogen for Women Continued

Thyroid for Men and Women -A review of primary, secondary and tertiary hypothyroidism and thyroid hypofunction. What are symptoms of hypothyroidism and thyroid hypofunction. What does the literature show and what’s all the controversy around T4 replacement vs T3/T4 combination. A review of the AACE guidelines and discussion on why patients feel better on a T3/T4 combo.

• Literature Review
• Types | Dosing | Methods of Administration
• Goals of Treatment
• Side Effects
• Concerns and Issues
• Indications | Contraindications
• Case Studies
Faculty: Lauren Fitzgerald, MD

Interactive Quiz - We will ask the questions, review answers in a fun and interactive way. Here is where we see what you understand and what you’re still struggling with that we can clarify.

Faculty: Kristi Hales, RPh

Clinical Practice Needs - What things should happen before you start seeing patients, a list of do’s and don’ts

• Lab testing and set up
• Billing Insurance
• Panels
• Lab ranges
• Testing and frequency
• Serum vs saliva
• Consents | Agreements | Documentation
• Advancing PCP’s in HRT
• Business Practice Models and Considerations
Faculty Panel Discussion

Common and more complex cases you will see. We will review labs for individuals of all ages both male and female with detailed case management discussions. This review brings together everything you learned over the weekend and prepares you to start seeing patients

High level overview of things you need to know. Consider this a cheat sheet you can refer to as you get started